Vogel C, Ziegelmüller B, Ljungberg B, Bensalah K, Bex A, Canfield S, Giles RH, Hora M, Kuczyk MA, Merseburger AS, Powles T, Albiges L, Stewart F, Volpe A, Graser A, Schlemmer M, Yuan C, Lam T, Staehler M.

Clinical Genitourinary Cancer (2018), doi: 10.1016/j.clgc.2018.07.024.


To systematically assess the diagnostic performance of contrast-enhanced CT in comparison to other imaging modalities for diagnosing and staging RCC in adults.

Evidence acquisition
A comprehensive literature search was conducted through various electronic databases. Data from the selected studies was extracted, pooled and median sensitivity and specificity calculated, wherever possible.

Evidence synthesis
40 studies comprising 4354 patients were included. They examined CT, MRI, PET/CT and ultrasound. For CT, median sensitivity and specificity were 88% (IQR 81-94%) and 75% (IQR 51-90%), for MRI they were 87.5% (IQR 75.25-100%) and 89% (IQR 75-96%). Staging sensitivity and specificity for CT were 87% and 74.5%, while MRI showed a median sensitivity of 90% and specificity of 75%. For ultrasound, the results varied strongly depending on the corresponding technique. CEUS attained a median diagnostic sensitivity of 93% (IQR 88.75-98.25%) combined with mediocre specificity. The diagnostic performance of unenhanced sonography was poor. For PET/CT diagnostic accuracy values were good, but based on only a small amount of data. Limitations include the strong heterogeneity of data due to the large variety in imaging techniques and tumour histotypes.

CECT and MRI remain the diagnostic mainstay for RCC with almost equally high diagnostic and staging accuracy. For specific questions a combination of different imaging techniques such as CT or MRI and CEUS may be useful. There is a need for future large prospective studies in order to further increase the quality of evidence.

Read on: Clinical Genitourinary Cancer (2018)

More from the InfoHUB